From the Guidelines
For diarrhea potentially caused by bacterial infection after anilingus, azithromycin is the recommended antibiotic due to its efficacy against a broad range of pathogens, including Shigella and Campylobacter, and its favorable safety profile 1.
Key Considerations
- The choice of antibiotic should be based on the suspected pathogen, with azithromycin being effective against Shigella and Campylobacter, which are common causes of diarrhea after anilingus.
- Before starting antibiotics, it is advisable to seek medical evaluation as many cases resolve with hydration and rest.
- Testing may be recommended to identify the specific pathogen.
Treatment Recommendations
- Azithromycin can be given as a single 1-gm dose or 500 mg daily for 3 days 1.
- It is essential to maintain hydration with water and electrolyte solutions, avoid alcohol, and complete the full course of antibiotics even if symptoms improve.
- Practicing safer sex with barriers like dental dams can prevent recurrence of these infections.
Important Notes
- If symptoms worsen, including high fever, bloody diarrhea, or severe abdominal pain, immediate medical attention is necessary.
- The use of fluoroquinolones, such as ciprofloxacin, may be limited due to concerns about resistance, particularly in cases where Campylobacter is suspected 1.
- Rifaximin, a nonabsorbable antibiotic, may be considered for non-invasive diarrhea caused by diarrheagenic E. coli, but it is less effective for invasive pathogens 1.
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
Ciprofloxacin is recommended for treating diarrhea caused by suspected bacterial infections, including those caused by Escherichia coli, Campylobacter jejuni, and Shigella species 2.
- The drug label indicates that ciprofloxacin is effective against these bacteria when antibacterial therapy is indicated.
- However, it is essential to note that antibiotic therapy should only be used when the infection is proven or strongly suspected to be caused by susceptible bacteria.
- Appropriate culture and susceptibility tests should be performed before treatment to isolate and identify the organisms causing the infection and determine their susceptibility to ciprofloxacin.
From the Research
Antibiotics for Diarrhea after Anilingus
- The recommended antibiotics for treating diarrhea caused by a suspected bacterial infection after engaging in anilingus are not explicitly stated in the provided studies, as they focus on different aspects of antibiotic treatment and diarrhea.
- However, based on the available information, the following antibiotics have been recommended for treating diarrhea caused by bacterial infections:
- Azithromycin, as the preferred first-line antibiotic for the treatment of acute watery diarrhea and febrile diarrhea/dysentery 3.
- Levofloxacin and ciprofloxacin, as options for acute watery diarrhea and febrile diarrhea/dysentery, although their effectiveness is decreasing due to increasing fluoroquinolone resistance 3.
- Rifaximin, as an alternative for acute watery diarrhea, but not recommended for invasive illness 3.
- It's essential to note that the choice of antibiotic should take into consideration the travel destination and regional differences in the predominance of pathogens and resistance levels 3.
- In cases of antibiotic-associated diarrhea, treatment with vancomycin or metronidazole may be effective, and the use of non-pathogenic living organisms, such as Saccharomyces boulardii, can help prevent or treat antibiotic-associated diarrhea 4.
- Metronidazole has been shown to be effective in combination with ciprofloxacin for treating mixed aerobic/anaerobic infections 5.
- Azithromycin has been used to treat Giardia intestinalis infection in a dog, suggesting its potential effectiveness against certain protozoal infections 6.